Researchers say that despite increasing medical knowledge, treating the rotator cuff remains one of the most challenging tasks in medicine. The problem? Continued shoulder tearing and degeneration after surgery.
Patient confidence in rotator cuff surgery is high. A lot of research shows that confidence is unfounded and misguided. Re-tear rate of a surgically repaired shoulder could be anywhere from 20 – 90%
- According to one athletic study from Loyola University Health System: “The results of (rotator cuff) treatment are not as predictable as the patient, family, trainer, coach and doctor would like to think.”(1)
- Doctors at the University of Montreal suggest that “Despite improvements in rotator cuff surgery techniques, re-tear rate remains above 20% and increases with tear severity. Early rehabilitation exercises could contribute to re-tear due to excessive stresses.”(2)
- There has long been a debate over the effectiveness of rotator cuff tear surgery. Numerous medical studies have shown that the re-tear rate of a surgically repaired shoulder could be anywhere from 20 – 90% depending on the patient circumstance. Australian researchers, presenting at the American Academy of Orthopaedic Surgeons (AAOS) 2012 Annual Meeting said that the failure rate they measured in 500 patients was 57%.
- University Hospitals of Geneva on failed surgical repair: “Tear recurrence can be related to various factors such as:
- (1) inadequate strength of the initial repair construct,
- (2) biological failure to heal despite strong initial fixation (hardware and suture) and
- (3) inappropriate postoperative rehabilitation causing structural failure of the repair”(3)
Rotator cuff surgery alternatives
In many articles on this site I discuss the growing interest medical researchers have in cellular communication. This interest is based on observations that stem cells, when introduced into a damaged joint, spontaneously change the joint environment from diseased to healing by signaling the native healing cells to get ready to rebuild.
- When introduced into a diseased joint, bone marrow stem cells display plasticity and multipotency (the ability to change/morph into other cell types and multiply). They also signal the native stem cells to join them.
- They also send signals to suppress inflammatory T–cell proliferation (inflammation) and provide an anti-inflammatory effect.
- Stem cells express various growth factors – an array of bioactive molecules that stimulate local tissue repair – These growth factors, and the direct cell to cell contact between MSCs and chondrocytes (the present remaining cartilage cells in the joint), have been observed to influence chondrogenic differentiation and cartilage matrix formation – in simple terms – stem cells regenerated cartilage.(4)
Now let’s look at the rotator cuff and the effects of cellular communication on repairing rotator cuff tears.
Doctors at various Chinese medical universities combined to publish new research on the need for alternatives to rotator cuff surgery. Enhancing cellular communication may be the answer.
“Rotator cuff tears are one of the most common shoulder problems that usually require operative treatments. Therapeutic options used to repair ruptured tendons have consisted of suture, autografts, allografts (transplants), and synthetic prostheses.
Although surgical treatments have improved dramatically up to now, shoulder pathology is still challenging to orthopedic surgery primarily because these injuries often respond poorly to treatment and require prolonged rehabilitation.
Recent attention has focused on several biologic pathways which can augment function to tendon healing, consequently leading to the identification of growth factors involved in this process.”(5)
Their attention were drawn to cytokines – small protein messengers instrumental in setting up signalling networks between healing factors. How do you stimulate cytokines? One way is to introduce stem cells into their network.
Stem cells create a non-surgical healing environment and this is why researchers from around the world are now pointing towards stem cell therapy as the future of rotator cuff repair and even to repair failed surgery damage. Here is new research to support that observation:
- Doctors from numerous teaching universities in Portugal published these findings: A new treatment approach (stem cell therapy for rotator cuff) for decreasing the characteristic muscle degeneration associated with chronic rotator cuff tears. This strategy is particularly important for patients whose tendon healing after later surgical repair could be compromised by the progressing degenerative changes.(6)
- From the University of Michigan: “Rotator cuff injuries are associated with atrophy and fat infiltration into the muscle, commonly referred to as “fatty degeneration.” As the poor function of chronically torn muscles may limit recovery after surgical repair, there is considerable interest in finding therapies to enhance muscle regeneration.” Those therapies include stem cells which can can improve muscle regeneration in other chronic injury states, and may be beneficial to enhance the treatment and recovery of patients with chronic rotator cuff tears.(7)
Watch the rotator cuff treatment with stem cells and then use the contact form to see if you are a candidate for this treatment for your rotator cuff problems.
Do you have a question about your rotator cuff issues for Dr. Darrow?
A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025
1. Nickolas G. Garbis, Edward G. McFarland. Understanding and Evaluating Shoulder Pain in the Throwing Athlete. Physical Medicine and Rehabilitation Clinics of North America, 2014; 25 (4): 735 DOI:10.1016/j.pmr.2014.06.009
2. Haering D, Blache Y, Raison M, Begon M. Mechanical risk of rotator cuff repair failure during passive movements: A simulation-based study. Clin Biomech (Bristol, Avon). 2015 Dec;30(10):1181-8.
3. Lädermann A, Denard PJ, Burkhart SS. Management of failed rotator cuff repair: a systematic review. Journal of Isakos. 2016;1(1):32-37. doi:10.1136/jisakos-2015-000027.
4. Seol D, Zhou C, et al. Characteristics of meniscus progenitor cells migrated from injured meniscus. J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472.
5. Wu G et al. Advances in the treatment of rotator cuff lesions by cytokines. Front Biosci (Landmark Ed). 2017 Jan 1;22:516-529.
6. Sevivas N, Teixeira FG, Portugal R, Araújo L, Carriço LF, Ferreira N, Vieira da Silva M, Espregueira-Mendes J, Anjo S, Manadas B, Sousa N, Salgado AJ. Mesenchymal Stem Cell Secretome: A Potential Tool for the Prevention of Muscle Degenerative Changes Associated With Chronic Rotator Cuff Tears. Am J Sports Med. 2016 Aug 8. pii: 0363546516657827.
7. Gumucio JP, Flood MD, Roche SM, Sugg KB, Momoh AO, Kosnik PE, Bedi A, Mendias CL. Stromal vascular stem cell treatment decreases muscle fibrosis following chronic rotator cuff tear. Int Orthop. 2016 Apr;40(4):759-64. doi: 10.1007/s00264-015-2937-x.